Definition
Calcaneal apophysitis / Pulling osteochondrosis
Epidemiology
Young boys
- peak age 10
- bilateral in 60%
Aetiology
Overuse injury of calcaneal apophysis
Repeated microfracture
History
Mechanical heel pain
Worse if barefoot
Examination
No redness or swelling
Tenderness on sides of tendon insertion
Restricted ankle dorsiflexion
Xray
Controversial whether normal
- increased fragmentation & density of apophysis
- may be the same on the other side
Primarily performed to exclude other conditions
- giant cell tumours
- UBC
Management
Algorithm
Restrict activities for 1-3 months
NSAIDs
- oral
- topical
Physio
- T achilles stretching / dorsiflexion exercises
Orthotics
- heel raises
- custom made heel cups & insoles
- short leg cast for 4/52 if symptoms severe